Neoadjuvant chemoradiotherapy for rectal cancer: How important is tumour regression?

M. J. McCoy, C. Hemmings, S. Hillery, C. Penter, M. K. Bulsara, N. Zeps, C. F. Platell

    Research output: Contribution to journalArticle

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    Abstract

    BACKGROUND: Pathological complete response following neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer is associated with reduced local recurrence and improved long-term outcome. However, the prognostic value of a partial response, or of tumour regression in patients with metastatic disease, is less clear. METHODS: We present a single-centre cohort study of 205 patients with stage II-IV rectal cancer treated with surgery and neoadjuvant CRT between 2006 and 2013. Tumour regression was assessed using the Dworak system. RESULTS: The probability of 3-year recurrence-free survival (RFS) was 95% for Dworak grade 4, 82% for grade 3, 64% for grade 2 and 53% for grade 1 (P = 0.0005). In univariate regression analysis, Dworak grade was associated with RFS (hazard ratio (HR) 0.51, P <0.0001; trend analysis) and cancer-specific survival (HR 0.52, P = 0.002). In multivariate analysis, Dworak grade remained an independent predictor of RFS (HR 0.62, P = 0.012), along with clinical metastases stage, resection margin status, the presence or absence of extramural venous invasion and type of surgical procedure. CONCLUSIONS: Tumour regression grade after neoadjuvant CRT was an independent prognostic factor for RFS, highlighting the importance of the degree of local response to CRT.
    Original languageEnglish
    Pages (from-to)E233-E239
    Number of pages7
    JournalANZ Journal of Surgery
    Volume87
    Issue number12
    Early online date3 Dec 2015
    DOIs
    Publication statusPublished - Dec 2017

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    Chemoradiotherapy
    Rectal Neoplasms
    Recurrence
    Survival
    Neoplasms
    Cohort Studies
    Multivariate Analysis
    Regression Analysis
    Neoplasm Metastasis

    Cite this

    @article{49e90cf3b68d474bb9fb46fc24fc80a3,
    title = "Neoadjuvant chemoradiotherapy for rectal cancer: How important is tumour regression?",
    abstract = "BACKGROUND: Pathological complete response following neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer is associated with reduced local recurrence and improved long-term outcome. However, the prognostic value of a partial response, or of tumour regression in patients with metastatic disease, is less clear. METHODS: We present a single-centre cohort study of 205 patients with stage II-IV rectal cancer treated with surgery and neoadjuvant CRT between 2006 and 2013. Tumour regression was assessed using the Dworak system. RESULTS: The probability of 3-year recurrence-free survival (RFS) was 95{\%} for Dworak grade 4, 82{\%} for grade 3, 64{\%} for grade 2 and 53{\%} for grade 1 (P = 0.0005). In univariate regression analysis, Dworak grade was associated with RFS (hazard ratio (HR) 0.51, P <0.0001; trend analysis) and cancer-specific survival (HR 0.52, P = 0.002). In multivariate analysis, Dworak grade remained an independent predictor of RFS (HR 0.62, P = 0.012), along with clinical metastases stage, resection margin status, the presence or absence of extramural venous invasion and type of surgical procedure. CONCLUSIONS: Tumour regression grade after neoadjuvant CRT was an independent prognostic factor for RFS, highlighting the importance of the degree of local response to CRT.",
    keywords = "chemoradiotherapy neoadjuvant therapy prognosis rectal neoplasms treatment outcome",
    author = "McCoy, {M. J.} and C. Hemmings and S. Hillery and C. Penter and Bulsara, {M. K.} and N. Zeps and Platell, {C. F.}",
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    Neoadjuvant chemoradiotherapy for rectal cancer : How important is tumour regression? / McCoy, M. J.; Hemmings, C.; Hillery, S.; Penter, C.; Bulsara, M. K.; Zeps, N.; Platell, C. F.

    In: ANZ Journal of Surgery, Vol. 87, No. 12, 12.2017, p. E233-E239.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Neoadjuvant chemoradiotherapy for rectal cancer

    T2 - How important is tumour regression?

    AU - McCoy, M. J.

    AU - Hemmings, C.

    AU - Hillery, S.

    AU - Penter, C.

    AU - Bulsara, M. K.

    AU - Zeps, N.

    AU - Platell, C. F.

    PY - 2017/12

    Y1 - 2017/12

    N2 - BACKGROUND: Pathological complete response following neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer is associated with reduced local recurrence and improved long-term outcome. However, the prognostic value of a partial response, or of tumour regression in patients with metastatic disease, is less clear. METHODS: We present a single-centre cohort study of 205 patients with stage II-IV rectal cancer treated with surgery and neoadjuvant CRT between 2006 and 2013. Tumour regression was assessed using the Dworak system. RESULTS: The probability of 3-year recurrence-free survival (RFS) was 95% for Dworak grade 4, 82% for grade 3, 64% for grade 2 and 53% for grade 1 (P = 0.0005). In univariate regression analysis, Dworak grade was associated with RFS (hazard ratio (HR) 0.51, P <0.0001; trend analysis) and cancer-specific survival (HR 0.52, P = 0.002). In multivariate analysis, Dworak grade remained an independent predictor of RFS (HR 0.62, P = 0.012), along with clinical metastases stage, resection margin status, the presence or absence of extramural venous invasion and type of surgical procedure. CONCLUSIONS: Tumour regression grade after neoadjuvant CRT was an independent prognostic factor for RFS, highlighting the importance of the degree of local response to CRT.

    AB - BACKGROUND: Pathological complete response following neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer is associated with reduced local recurrence and improved long-term outcome. However, the prognostic value of a partial response, or of tumour regression in patients with metastatic disease, is less clear. METHODS: We present a single-centre cohort study of 205 patients with stage II-IV rectal cancer treated with surgery and neoadjuvant CRT between 2006 and 2013. Tumour regression was assessed using the Dworak system. RESULTS: The probability of 3-year recurrence-free survival (RFS) was 95% for Dworak grade 4, 82% for grade 3, 64% for grade 2 and 53% for grade 1 (P = 0.0005). In univariate regression analysis, Dworak grade was associated with RFS (hazard ratio (HR) 0.51, P <0.0001; trend analysis) and cancer-specific survival (HR 0.52, P = 0.002). In multivariate analysis, Dworak grade remained an independent predictor of RFS (HR 0.62, P = 0.012), along with clinical metastases stage, resection margin status, the presence or absence of extramural venous invasion and type of surgical procedure. CONCLUSIONS: Tumour regression grade after neoadjuvant CRT was an independent prognostic factor for RFS, highlighting the importance of the degree of local response to CRT.

    KW - chemoradiotherapy neoadjuvant therapy prognosis rectal neoplasms treatment outcome

    U2 - 10.1111/ans.13394

    DO - 10.1111/ans.13394

    M3 - Article

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    JO - Australian New Zealand Journal of Surgery

    JF - Australian New Zealand Journal of Surgery

    SN - 1445-1433

    IS - 12

    ER -